Provider Demographics
NPI:1760767420
Name:AGBO, PETER (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:AGBO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5506 S DUPONT HWY
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-6410
Mailing Address - Country:US
Mailing Address - Phone:302-698-6320
Mailing Address - Fax:
Practice Address - Street 1:5506 S DUPONT HWY
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-6410
Practice Address - Country:US
Practice Address - Phone:302-698-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003953183500000X
MD19396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist